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Clinical characteristics and unlicensed applications of licensed psychotropic drugs within a regional tertiary service for patients with affective disorders

Clinical characteristics and unlicensed applications of licensed psychotropic drugs within a regional tertiary service for patients with affective disorders
Clinical characteristics and unlicensed applications of licensed psychotropic drugs within a regional tertiary service for patients with affective disorders
Objectives: referral to tertiary services is recommended when patients with mood and anxiety disorders have not responded to multiple treatments in primary or secondary care. Within specialist services some patients undergo treatment with licensed psychotropic medications outside the narrow terms of their market authorisation (‘unlicensed applications’). We examined the demographic and clinical characteristics of patients referred to a regional specialist service, to determine the extent of and factors associated with recommendations for unlicensed (‘off-label’) prescriptions.

Methods: retrospective examination of demographic and clinical characteristics and treatment recommendations in patients seen within a five-year period. Patients were allocated to three broad diagnostic clusters (unipolar depressive disorders, bipolar disorder, anxiety disorders), and two groups (with or without comorbid disorders). We compared patients in whom all treatment recommendations were for licensed applications with patients in whom at least one treatment was for an unlicensed application, across a range of variables reflecting illness ‘burden’ (duration, inpatient treatment, ECT, non-fatal self-harm, psychosis).

Results: from 177 new referrals, 148 patients (91 females, 57 males) could be placed within one of the three clusters. Many patients with bipolar disorder had not undergone treatment with lithium or formal psychological interventions in secondary care. Treatment recommendations involving unlicensed applications of medications were common (approximately 50%) in all clusters, but there were no significant differences in measures of illness burden between groups of patients, categorised according to licensed or unlicensed prescriptions.
Limitations. Retrospective examination of notes recorded for other purposes, within a single service, in which treatment recommendations might reflect idiosyncratic practice. Examined variables could not provide a comprehensive indication of illness severity or functional impairment.

Conclusion: our findings confirm that ‘off –label’ prescribing is common in psychiatric practice. Treatment decisions relating to unlicensed applications appear to be influenced by factors other than overall illness burden.

off –label’ prescribing, , , unlicensed psychotropic medications, licenced psychotropic medications, Affective disorder services, ertiary Mood and Anxiety disorder services.
2045-1253
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Tiwari, Napur
84b67114-bde6-4ead-a2d5-5a55d19d0547
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Tiwari, Napur
84b67114-bde6-4ead-a2d5-5a55d19d0547

Baldwin, David and Tiwari, Napur (2018) Clinical characteristics and unlicensed applications of licensed psychotropic drugs within a regional tertiary service for patients with affective disorders. Therapeutic Advances in Psychopharmacology. (In Press)

Record type: Article

Abstract

Objectives: referral to tertiary services is recommended when patients with mood and anxiety disorders have not responded to multiple treatments in primary or secondary care. Within specialist services some patients undergo treatment with licensed psychotropic medications outside the narrow terms of their market authorisation (‘unlicensed applications’). We examined the demographic and clinical characteristics of patients referred to a regional specialist service, to determine the extent of and factors associated with recommendations for unlicensed (‘off-label’) prescriptions.

Methods: retrospective examination of demographic and clinical characteristics and treatment recommendations in patients seen within a five-year period. Patients were allocated to three broad diagnostic clusters (unipolar depressive disorders, bipolar disorder, anxiety disorders), and two groups (with or without comorbid disorders). We compared patients in whom all treatment recommendations were for licensed applications with patients in whom at least one treatment was for an unlicensed application, across a range of variables reflecting illness ‘burden’ (duration, inpatient treatment, ECT, non-fatal self-harm, psychosis).

Results: from 177 new referrals, 148 patients (91 females, 57 males) could be placed within one of the three clusters. Many patients with bipolar disorder had not undergone treatment with lithium or formal psychological interventions in secondary care. Treatment recommendations involving unlicensed applications of medications were common (approximately 50%) in all clusters, but there were no significant differences in measures of illness burden between groups of patients, categorised according to licensed or unlicensed prescriptions.
Limitations. Retrospective examination of notes recorded for other purposes, within a single service, in which treatment recommendations might reflect idiosyncratic practice. Examined variables could not provide a comprehensive indication of illness severity or functional impairment.

Conclusion: our findings confirm that ‘off –label’ prescribing is common in psychiatric practice. Treatment decisions relating to unlicensed applications appear to be influenced by factors other than overall illness burden.

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Accepted/In Press date: 20 April 2018
Keywords: off –label’ prescribing, , , unlicensed psychotropic medications, licenced psychotropic medications, Affective disorder services, ertiary Mood and Anxiety disorder services.

Identifiers

Local EPrints ID: 421020
URI: https://eprints.soton.ac.uk/id/eprint/421020
ISSN: 2045-1253
PURE UUID: 8629e3ed-17af-4ae4-a731-11b7701ffe07

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Date deposited: 21 May 2018 16:30
Last modified: 13 Mar 2019 18:29

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